Obama proposes ‘self plus one’ health plan enrollment option

Apr. 10, 2013 - 01:02PM
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Federal employees would be able to sign up for a “self plus one” health plan beginning in 2015 under Federal Employee Health Benefits Program reforms the White House is proposing in its fiscal 2014 budget.

Currently, FEHBP enrollees can only sign up for self-only or family health plans. This means that federal employees who are married without children, or who are single parents of just one child, have to sign up for more expensive family plans. Creating a self-plus-one option, as the administration wants, would let those employees save money.

The administration also wants to open FEHBP to the domestic partners of federal employees and new retirees. The budget does not say whether those domestic partners would be only opposite-sex, or if same-sex partners would be included. The controversial Defense of Marriage Act, which defines marriage as between one man and one woman, prevents the federal government from extending FEHBP benefits to same-sex spouses and same-sex partners of federal employees. But if the Supreme Court strikes down DOMA, that restriction would be lifted.

In addition, the budget proposes authorizing the Office of Personnel Management to adjust health care premiums based on enrollees’ tobacco use or participation in a wellness program.

The budget proposes expanding the types of health plans available to federal employees. However, the budget does not define what additional types of plans would be permitted.

The budget also would enable OPM to strike is own deals with pharmacy benefit managers, or PBMs, for prescription drugs. PBMs are companies that negotiate prescription drug prices with pharmaceutical companies on behalf of FEHBP’s insurance providers. But PBMs are not considered subcontractors, and as a result, OPM has little oversight of them and cannot be sure they pass on rebates to FEHBP enrollees.

The administration said the proposed changes would save $8.4 billion over 10 years.